SOCIAL CLASS AND MENTAL ILLNESS

1. SOCIAL CLASS AND MENTAL ILLNESS

2. WHAT IS SOCIAL CLASS? • PEOPLE SIMILAR IN ECONOMIC AND SOCIAL STATUS, EDUCATION, WAYS OF LIFE, ATTITUDES AND BELIEFS • TWO MAJOR ASPECTS • MATERIAL RESOURCES – FINANCIAL • CULTURE - EDUCATION, TASTE

3. MEASURES • INCOME • EDUCATION • COMBINATION (UPPER; MIDDLE; WORKING; LOWER) • STATUS INCONGRUITY

4. CAUSE AND EFFECT • CAUSATION - SOCIAL CLASS PRECEDES M.I. • MORE ACUTE AND CHRONIC STRESSORS • MORE VULNERABILITY • WORSE TREATMENT • IF CAUSE -RESOURCES OR CULTURE?

5. SOCIAL CLASS AS EFFECT • SELECTION - M.I. PRECEDES SOCIAL CLASS • DOWNWARD DRIFT

6. PSYCHOSIS

7. FARIS AND DUNHAM • CHICAGO 1939 • ADMISSIONS TO MENTAL HOSPITALS BY AREAS OF CITY • NO ASSOCIATION BETWEEN RESIDENCE AND BI-POLAR • STRONG ASSOCIATION BETWEEN RESIDENCE IN CENTRAL CITY AND SCHIZOPHRENIA (9x DIFFERENCE)

8. FARIS AND DUNHAM • ORIGINALLY SAID ISOLATION OF CENTRAL CITY CAUSES SCHIZ. • LATER CHANGED MIND AND SAID PEOPLE FIRST BECOME SCHIZ AND THEN MOVED TO CENTRAL CITY • SELECTION

9. RECENT STUDIES • SCHIZ ALWAYS ASSOCIATED WITH LOWER SOCIAL CLASS • WHAT IS CAUSE AND WHAT EFFECT? • LOOK AT PARENTS’SOCIAL CLASS • SELECTION MORE THAN CAUSATION • DOWNWARD DRIFT • BIPOLAR NOT RELATED TO S.C.

10. NON-PSYCHOTIC

11. INCOME AND M.I.

12. INCOME AND M.I.

13. NON-PSYCHOTIC • LOWER CLASS ALWAYS HIGHEST • SOMETIMES INVERSE, SOMETIMES NOT • STRONGEST FOR ANXIETY • WEAKEST FOR SUBSTANCE ABUSE • LOWER CLASS ESPECIALLY LIKELY TO HAVE COMORBID DISORDERS

14. REASONS FOR NON-PSYCHOTIC • CAUSATION NOT SELECTION • STRESSORS • MODEST RELATIONSHIP WITH ACUTE LIFE EVENTS • STRONGER RELATIONSHIP WITH CHRONIC STRESSORS

15. OCCUPATIONAL REASONS (LENNON) • HIGHER SOCIAL CLASSES HAVE MORE AUTONOMY AND CONTROL OVER WORK • HIGHER SOCIAL CLASSES HAVE FEWER PHYSICAL STRESSORS OF WORK • HIGHER SOCIAL CLASSES HAVE MORE JOB STABILITY

16. VULNERABILITY • LOW SOCIAL CLASS ESPECIALLY VULNERABLE TO STRESSORS • LESS ADEQUATE MATERIAL SUPPORT AND COPING • LEADS TO LONGER DURATION AND POORER PROGNOSIS FOR LOWER CLASSES

17. TREATMENT

18. SOCIAL CLASS AND TREATMENT • INCIDENCE = NEW CASES • PREVALENCE = ALL CASES • PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS • HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s

19. TREATMENT OF PSYCHOSES

20. TREATMENT OF PSYCHOSES • NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER CLASS HAS MORE • STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND PREVALENCE OF PSYCHOSES

21. EXPLANATIONS • MORE CONTINUING STRESSORS FOR LOWER CLASS • WORSE PSYCHIATRIC TREATMENT FOR LOWER CLASS • MORE COMMUNITY SUPPORT FOR HIGHER CLASSES • LONGER DURATION AND WORSE PROGNOSIS FOR LOWER CLASSES

22. TREATMENT OF NEUROSES

23. TREATMENT OF NEUROSIS • NO DIFFERENCE IN NEW CASES • HIGHER CLASSES HAVE MUCH GREATER TREATED PREVALENCE • HIGHER CLASSES STAY MUCH LONGER IN TREATMENT • RELATIONSHIP FOR PREVALENCE OPPOSITE FOR NEUROSES AND PSYCHOSES

24. REASONS • CULTURE OF HIGHER CLASSES MORE CONGRUENT - ESPECIALLY EDUCATION • LESS STIGMA FOR HIGHER CLASSES • RESOURCE DIFFERENCES • RESPONSE OF M.H. PROFESSIONALS

25. SUMMARY • SOCIAL CLASS HAS STRONG ASSOCIATION TO M.I. • PSYCHOSES - SELECTION • NON-PSYCHOTIC – CAUSATION • STRESSORS AND VULNERABILITY • HIGHER CLASSES MORE OUTPATIENT AND LESS INPATIENT

26. SUMMARY (CONT.) • LOWER CLASSES MORE INPATIENT AND LESS OUTPATIENT